Diagnosed and conflicted on treatment options

One of the biggest myths about prostate cancer treatment is the pro-surgery talking point that "you can't have surgery if radiation fails".

Yeah, but so what?

Cryotherapy, HIFU, FLA, IRE, SBRT, and HDRBT have all been proven effective for salvage treatment if primary radiation fails.  Did your urologist (surgeon) discuss these options with you? I thought not!

IMHO, you need to ask many more questions before ruling out any treatments.

Max Former Hodgkins Stage 3 said:

Perspective

Mike35,

If you undergo surgery, what usually happens is short-term incontinence (a few months or so, with some potential for light dribble beyond), and six months or more impotence.  Most men without ED before surgery get throught he ED afterward, within a year or thereabout.

MK1965s experience regarding potency is the worst I've ever followed here.  He has an important role here as a voice of worst-case potency outcomes for RP.  Yet even he is testing cured of the cancer (based on PSA results), and recently reported urinary continence had retured for him.  

But it deserves to be said that worst-case also means "not usual case."   For ever critic of RP here among men who have had it, I would say that 90% are pleased.  I've known many men who had RPs, and never heard any one of them complain about anything.

Take your time and consider all options well before confirming a choice,

max,

DaVinci, Jan 2015

 

Max,

if you reread my first response on this tread 4+3, you will see I did not mention single word about my outcome except saying “everyrhing else is known to this forum”.

Honestly, I did not see any reason for stoning me and my outcome.

MK

Mike -

I seriously considered HIFU, but went with RP, and am glad I did.  I had a known tumor (3+4) in the right lobe of the prostate, but was concerned if I had the HIFU that there might also be some cancer in the left lobe.  I didn't want to go through all this again.  Post surgical examination revealed a second tumor in the left lobe.  Had I not had the RP, that cancer likely would have grown and I'd have to repeat this whole process over again.  HIFU looked like the best solution to me - and was willing to pay the $20K dollars to get it done myself (some insurance will not pay for HIFU), but until the prostate can be accurately visualized for tumors, I'm not sure it is the way to go.

Josephg said:

Worst Outcomes

Folks,

I think that we need to calm down a bit here.  The one thing that we need to try to control at all costs are our emotions.  I know, much easier said than done.  We do ourselves and our new readers a disservice, if we let emotion swell up over logic and objectivity in this forum (and life, in general).

Regarding worst outcomes from RP, I probably am closer to that end of the spectrum than the other end.  Read my history here.  I had RP performed at a world class institute by a surgeon with over 2200 previously performed RPs.  My RP was performed over 6 years ago, and I've been totally incontinent and ED since then.  However, prior to surgery, my surgeon asked if my priority was to be hopefully rid of the cancer, or to remain continent without ED, and I told him that removing the cancer was my #1 priority.  So, he proceeded accordingly.

My RP failed, and my subsequent adjunct radiation and hormone therapy failed, as well.  And, I've probably had almost all of the side effects possible, associated with each of these therapies.  HOWEVER, and this is important, I made all of those therapy choices, myself, based upon the best information that I could find, including the very sage advice from members of this forum.  And, I have no regrets.  Why, because I can still lead a fairly normal lifestyle and participate in most of the activites that I enjoyed, prior to my PCa (with the one obvious exception).

If I had not chosen to aggressively fight this PCa with all of the tools currently available, today, I would most likely be suffering in stage 4 PCA, looking at 1-2 years of remaining life.  Instead, I am living a very good life, with a projected 10-15 (12 median) years of life left before PCa kills me.  And, that does not include any provision for new therapies that will most likely become available over the next 10 years.

I am quite content at this point in my life, and I live every day and year, as if it is my last, and that is something that I did not do, prior to PCa.  Respectfully submitted for your consideration.

I am going for my RP on 03/20/2018.  I am 67 years old.  Gleason 4+3=7.  To me you cut right to the point.  We can always build a better plane, but sooner or later you are going to have to fly that plane.  It is what it is.  Cancer is the primary target.  Repercussions are secondary.  Best wishes.

Radiation cure rate is comparable to surgery with less side effects.....when we are diagnosed, we simply want to get rid of the cancer, thus many including you, look to surgery.

Targeted HIFU may not cure since technology in my opinion is not advanced to determine multi-focal cancers, and is less likely to cure.

Instead of having another MRI and fusion biopsy, why not use the previous MRI and go back to the spot where the 4+3 is located and biopsy the areas surounding the 4+3, as well as other suspicious lessions and random.....the  targeted , three dimensional biopsy that you had , has this capability....and in my laymans opinion will provide a better understanding of what is going on.

Again Hopeful, your comments are misleading and based on your opinion.  The comments that I posted are from actual users on this forum not something I made up.  People here need to get the straight facts based on the people's experience of this forum, studies, and the actual manufactures of both surgical & radiation equipment, not opinions. People know that both radiation & surgery have similar longevity results, various online doctor studies have proved that, but it's all about the side effects, sometimes long lasting and debilitating.  I don't think surgery is better than apple pie, both surgery & radiation have side effects sometimes serious, but I do like apple pie with a small dab of vanilla ice cream on top.

Dave 3+4

Instead of cannibalism this thread, as you and the other surgery advocates have done on others, why not start a new thread devoted to this subject. 

It is your body, your mind, your cancer, your choice.  It is your choice, right or wrong.  If you cannot make a decision, that is a decision in itself.  This is a wonderful site with a lot of great information, but the bottom line comes down to me.  What do I want to do?  What are the specialists telling me?  Y'all be thinking about me when I go in on March 20 to try and make sure this 300lb gorilla that is trying to escape my prostate doesn't.  I am an old retired Air Force Chief Master Sergeant.  I have seen many different models of airplanes that have been made better.  But when it is all said and done you are going to have and fly that airplane eventually.  Good luck to you folks and best wishes.

Instead of promoting or disparaging one treatment over another, we have to consider the variables that make successful treatments versus perceived unsuccessful ones.

The fact that there is BOTH says the are variables in play. If CG says his surgery is successful without lasting side effects, but MK is angry that his was unsuccessful and has permanent ED as he claims.. THEN WHAT WAS DIFFERENT? 

I kept tyring to get MK to pinpoint the variable that made his unsuccessful, but he continued to react emotionally and condemn RP wholesale. This is what is irritating for us because we cannot get to the bottom of his bad results to warn others to avoid THAT PARTICULAR SITUATION rather than just condemn radical prostatectomy.

But CG and myself did not have severe permanent side effects, so that is self evident PROOF that it is a useful treatment in some cases, but maybe not in others.

If anyone wants to condemn DaVinci RP, then let them bring the variables to light that will allow a PC patient to look at those variables and decide if they apply to HIS PARTICULAR SITUATION.

I suspect the most likely variable is Davinci experience of the surgeon. If you read into the archives, for both instances of RP AND Radiation, thete is a CORRELATION between experience of the surgeon/ oncologist and the incidence of side effects.

Emotion plays no part in science. There is only variables and how they effect outcomes.

Interesting discussion.  

Yes, that's what drives a person crazy about this disease: too many choices, starting with one of the most basic of all -- surgery versus radiation versus surveillance.

Personally, I went the surgery route myself, a couple months ago, and so far so good.  Except of course it hasn't been "far" at all yet.  Long way to go still.

That said, to this point the side effects with regard to continence have been minimal -- (knock on wood).  ED is a bit of an issue but there've already been signs of life, so to speak, in that department as well. 

Moreover, pathology showed the cancer was organ-confined, which was a big relief.  The major negative news: the Gleason number was upgraded to high-risk, which I guess increases the chances of biochemical recurrence.  We'll see.

Going back to the choice of treatment, I definitely wrestled with the decision.  I would have jumped on surveillance had it been remotely an option, but since the biopsy indicated Gleason 4-3, the docs took that off the table.

Radiation was tempting.  Somehow it seemed less scary and drastic than surgery.  However, because of the Gleason score, the docs wanted me to do six months of HT in addition.  The possible side effects of that, both during treatment and for several months afterward, were a major negative consideration.

In the end, I went with surgery because I'm lucky enough to live very near a top hospital with an outstanding urology department and some of the best urologic surgeons in the country.  For me, this proved the decisive factor.

So I think the issue is far from simple.  (Indeed, nothing seems to be simple with prostate cancer.)  Guys should ask themselves (and their doctors) whether there's a good chance the cancer is organ-confined.  If not, surgery may not be the best way to go, as you may well end up needing radiation in the end anyway.

Also, if radiation is the initial treatment choice, will I need HT to go with it?  If so, then add that in when weighing the package of side effects.

And critically, do I have access to a very skilled and experienced surgeon, with a demonstrated track record of success in performing this difficult operation?  If not, then you're taking a big chance with surgery.

Anyway, a lot of you guys know much more about this whole thing than I, but hopefully you won't mind me throwing my two cents in.  I've been pretty lucky so far, and I just hope my luck holds.